Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 007474-1 | NY |
NPI | 1003162280 |
---|---|
Provider Name | Mr. Aleksandr Shimunov |
First Address | Fresh Meadows, NY 11365 |
Second Address | Bronx, NY 10452-1503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 02/08/2017 |